Hip disease in ankylosing spondylitis

Area of Science:

• Rheumatology
• Orthopedics
• Immunology

Background:

• Hip disease is a common and disabling complication of ankylosing spondylitis (AS).
• It affects approximately one-third of AS patients and can necessitate total hip replacement, particularly in young adults.
• Recent research has focused on the epidemiology, pathology, diagnosis, prognosis, and management of hip involvement in AS.

Purpose of the Study:

• To review recent studies on the diagnosis, prognosis, and therapeutic management of hip disease in patients with ankylosing spondylitis.
• To provide an updated overview of current understanding and clinical recommendations for hip involvement in AS.

Main Methods:

• Review of recent large-scale studies and clinical data on hip involvement in AS.
• Evaluation of diagnostic modalities including clinical examination, radiology, MRI, and ultrasonography.
• Assessment of treatment outcomes for anti-tumour necrosis factor (TNF) agents and surgical interventions.

Main Results:

• Hip disease in AS is more prevalent in patients with earlier disease onset and more severe axial disease.
• Diagnostic methods like clinical exam, radiology, MRI, and ultrasonography reveal different aspects of hip involvement.
• Anti-TNF agents show efficacy in pain relief and functional improvement for active axial and hip disease, though their effect on structural progression is unclear.
• Total hip replacement is indicated for end-stage hip disease.

Conclusions:

• Routine clinical assessment of hips is recommended for all patients with AS.
• Anti-TNF therapy should be considered for AS patients with NSAID-resistant active axial disease and concurrent hip disease.
• Prompt diagnosis and management are crucial to mitigate disability from hip disease in AS.